Insurance Managed Care RN

Found in: Resume Library US A2 - 2 weeks ago

Rock Island Illinois, United States UnityPoint Health Full time
Overview:
Insurance Managed Care RN - UR/CM

Precedence, Inc., Rock Island, IL

Remote or Hybrid with Experience - Based Off Of Location

Full-Time + Benefits

PRN

 

*Seeking candidate with insurance expereince*

 

The Managed Care RN Utilization/Case Manager, under the direction of the Director of Managed Care serves a key role in coordinating the patient’s/enrollees interdisciplinary providers/services to assess and effectively use resources and to track and minimize the inappropriate use of such resources while providing the right care at the right level at the right time. This role is responsible for utilization management and case management for patients/enrollees. This includes payment authorizations, clinical coordination, integration and facilitation of all care and services for the patient by all members of the health care team.

This role performs admission assessment, continued stay reviews all according to established criteria of third party carriers, and as found necessary on cases with third party payor review. Monitoring of plan of care to address physical and psychosocial needs, and provide problem solving assistance. Coordinates services, discharge planning, referrals to appropriate community agencies and assists with Advance Directives when appropriate. Responsible for reviewing and updating critical paths with healthcare team when applicable.  Also, assessing, monitoring, analyzing and documenting resources utilized in the provision of patient care.

 

 

Why UnityPoint Health?

Culture – At UnityPoint Health, you Come for a fulfilling career and experience guided by uncompromising values and unwavering belief in doing what's right for the people we serve.

Benefits – Our competitive program offers benefits options like 401K match, paid time off and education assistance that align with your needs and priorities, no matter what life stage you’re in.

Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.

Development – We believe equipping you with support and is an essential part of delivering a remarkable employment experience.

Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.

 

Visit us at (url removed)/careers to hear more from our team members about why UnityPoint Health is a great place to work.

 

#RYCJessi

Responsibilities:
Performs utilization and case management reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources and payment approval.Applies utilization criteria using designated software to complete documentation related to utilization review activities in an accurate and timely manner for the purpose of providing information for other members of the healthcare team and to facilitate decision making.

Requests reviews with physician advisors, and/or Executive Health Resources (EHR), as appropriate, if admission or continued stay criteria are not met, assuring appropriate and timely level of care status.

Applies accepted potentially avoidable day logic to reviews so that accurate and timely data collection may occur.

Conducts payment authorizations and coordinated payment denials while meeting timeliness guidelines.

Serves as a resource to internal and external staff on issues related to utilization management

Maintains current knowledge of Utilization and Case Review Methodology, software, criteria and regulations governing various payment systems.

Maintains current knowledge of URAC guidelines

Coordinates and monitors appeals internal and with outside organizations used for Second Level Review (e.g. IRO) as needed

Works with physicians regarding utilization issues as needed.

Ensures appropriate discharge/follow up planning

Ensures case coordination with client’s health care providers

Provides utilization management and case management to designated enrollees. Assuring that all enrollees receive clinically sound triage/referral and ongoing care management services for medical needs

Maintains 100% compliance with the laws, standards, rules and regulations of regulatory agencies including but not limited to: URAC, Medicaid, Medicare

Consulting with the medical director/peer reviewer on all high-risk and/or complicated cases, re-admissions and stays over six (6) days

Provides documentation of enrollee contacts and clinical care as it occurs.

Brings any questions or concerns to supervisor for resolution to help facilitate work being meaningful and fulfilling.

Brings a passionate, positive and compassionate attitude to work.

Coordinate the development of patient centered case management.

Qualifications:
Education:

Registered Nurse

Experience:

5+ years of nursing experience

License(s)/Certification(s):

Registered Nurse – Illinois Licensed

Knowledge/Skills/Abilities:

Professional Communication – written & verbal

Customer/patient focused

Self-motivated

Managing priorities/deadlines

Flexibility to adapt to changing priorities or needs

Planning and organizing skills

MS Office proficiency (Outlook, Word)

Ability to give work direction to non-clinical staff

  • Insurance Managed Care RN

    Found in: Resume Library US A2 - 1 week ago

    Rock Island, Illinois, United States UnityPoint Health Full time

    Overview: Insurance Managed Care RN - Case Manager Precedence, Inc., Rock Island, IL Remote or Hybrid with Experience - Based Off Of Location Full-Time + Benefits     *Seeking candidate with insurance expereince*   The Managed Care RN Utilization/Case Manager, under the direction of the Director of Managed Care serves a key role in coordinating...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Woodridge, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Woodridge, IL Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Lockport, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Lockport, IL Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Naperville, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Naperville, IL Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Wheaton, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Wheaton, IL Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Lisle, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Lisle Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly Health...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Naperville, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Naperville Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Joliet, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Joliet Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly Health...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Westmont, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Westmont Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Saint Charles, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: St. Charles, IL Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Oak Lawn, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Oak Lawn Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Orland Park, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Orland Park Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly...

  • RN Case Manager

    Found in: Resume Library US A2 - 3 days ago

    Tinley Park, Illinois, United States Duly Health and Care Full time

    Overview: Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Location: Tinley Park Good enough isn’t for us. Duly Health and Care’s team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work. Duly...

  • RN Home Care

    Found in: Resume Library US A2 - 4 days ago

    Ottawa, Illinois, United States OSF HealthCare Full time

    Overview: OSF will invest in you day 1!  Candidates with 5+ years of direct experience will receive a bonus of 24 hours of Vacation/Vacation time frontloaded on day 1.  This is in addition to our generous Paid Time Off plans!   $3.25 Weekend Differential   Expected pay for this position is $32.08 - $40.41/hour. Actual pay will be determined by...

  • RN Home Care

    Found in: Resume Library US A2 - 2 weeks ago

    Peoria, Illinois, United States OSF HealthCare Full time

    Overview: OSF will invest in you day 1!  Candidates with 5+ years of direct experience will receive a bonus of 24 hours of Vacation/Vacation time frontloaded on day 1.  This is in addition to our generous Paid Time Off plans!   $3.25 Weekend Differential   Expected pay for this position is $32.08 - $40.41/hour. Actual pay will be based off of...

  • RN Home Care

    Found in: Resume Library US A2 - 3 days ago

    Ottawa, Illinois, United States OSF HealthCare Full time

    Overview: OSF will invest in you day 1!  Candidates with 5+ years of direct experience will receive a bonus of 24 hours of Vacation/Vacation time frontloaded on day 1.  This is in addition to our generous Paid Time Off plans!   $3.25 Weekend Differential   Expected pay for this position is $32.08 - $47.20/hour. Actual pay will be determined by...

  • RN Home Care

    Found in: Resume Library US A2 - 4 days ago

    Peoria, Illinois, United States OSF HealthCare Full time

    Overview: Expected pay for this position is $32.08 - $40.41/hour. Actual pay will be determined by experience, skills and internal equity.   OSF will invest in you day 1!  Candidates with 5+ years of direct experience will receive a bonus of 24 hours of Vacation/Vacation time frontloaded on day 1.  This is in addition to our generous Paid Time Off...

  • RN Home Care

    Found in: Resume Library US A2 - 2 weeks ago

    Ottawa, Illinois, United States OSF HealthCare Full time

    Overview: Eligible for $10,000 Sign on Bonus - external candidates $5,000 Sign on Bonus for New Grad RNs - internal and external candidates   OSF will invest in you day 1!  Candidates with 5+ years of direct experience will receive a bonus of 24 hours of Vacation/Vacation time frontloaded on day 1.  This is in addition to our generous Paid Time Off...

  • Travel Nurse

    Found in: Talent US C2 - 6 days ago

    Rock Island, United States TLC Travel Staff Full time

    TLC Travel Staff is seeking an experienced Oncology Registered Nurse for an exciting Travel Nursing job in Rock Island, IL. Shift: 3x12 hr days Start Date: 05/20/2024 Duration: 13 weeks Pay: $2237.95 / Week Job Description: Position Type: Travel Nursing Specialty: NursingRN Oncology Experience:Candidates must have a minimum of...

  • FT/PT RN 2nd and 3rd Shift

    1 day ago

    Rock Island, United States FRIENDSHIP MANOR INC Full time

    Job DescriptionJob DescriptionDescription:Friendship Manor is a great place to work! We're a faith-based, non-profit, senior living community and we've been a big part of the Quad Cities since 1979. We are currently looking for RN's and LPN's for our Skilled Nursing Unit. You must have a current RN/LPN license in IL. The primary purpose of...